Monday, 23 February 2015

Clinicians’ use of smartphones at work

After 20 years of prohibition the blanket ban on mobile phones in hospitals was lifted. Smartphones and mobile computing devices are becoming an integral part of working lives in almost every industrial and professional field. Use of such devices presents opportunities and challenges for professional nursing practice: enhanced clinician and patient education, patient engagement (Doswell et al. 2013) and communication (Wu et al. 2011), but also potential erosion of professional behaviours and attitudes, patient privacy, confidentiality, safety (Westbrook et al. 2010) and infection control (Brady et al. 2007). McBride (2015) focuses on one aspect of risk – that posed by clinician distraction by smartphone use. Citing claims that lack of consensus definition is hampering progress in understanding and managing this hazard, McBride sets out to address this by undertaking a concept analysis.

There is no question that this topic is contentious, and that the pace of changing practice has far outstripped research and policy. Surveys suggest that over 70% of nurses and physicians already use smartphones in daily clinical practice (Dolan 2012, Kiser, 2011), with over 30,000 medical apps (applications) available across all mobile device platforms (PocketGamer.biz 2015). While this may decrease the need for clinicians to commit and retrieve information from memory (thereby reducing error potential), how this is managed within routine care is less clear. There is little clear evidence this is a problem in healthcare, and issues elsewhere of appropriate use but inappropriate timing have been conflated with inappropriate use (‘cyber-loafing’). How patients feel if their nurse is using a phone is unknown. Do they feel any less cared for? Do patients accept that clinicians are not necessarily a fount of information and may need to look things up? (But wouldn't they rather clinicians did if they needed to?) However, lack of robust regulation and peer review processes are causing growing concerns over the credibility of information provided by some applications (Haffey et al. 2013), whilst deficiencies have been flagged in some nurses’ knowledge and discrimination of internet resources (Gilmour et al. 2008). Further, whilst combining high resolution photography and messaging (text, voice) allows sharing of more detailed information between clinicians (Hsieh et al. 2015), this may entail transmission across unsecured devices and networks. The urgent need for health technology development and uptake, and research-based policy, is obvious.

Does this concept analysis progress this agenda? A concept analysis has merits as a mechanism to establish clarity where there is otherwise inconsistency or confusion. A critic might consider the attributes of distraction identified in this paper obvious as well as evidence-derived, but this is perhaps irrelevant if the paper establishes consensus. The temptation on the part of policy-makers might be to see this paper as vindication of smartphone use as ‘distraction’ and hence problem. The situation is clearly more complex, with urgent need for high quality information on a range of perspectives.

In the short term, a return to knee-jerk blanket bans is neither appropriate nor achievable. Whilst we wait for the research and new technologies, policy-makers are probably prudent in adopting a cautious approach. A concept analysis may help with this.